Personality disorders are characterized by long-term patterns of behavior that interfere with everyday life. These disorders can impact a person’s jobs, relationships, and friendships, as they manifest in very rigid and irrational behaviors that may cause problems with other people. Personality disorders are broken into three clusters. Cluster B is characterized as dramatic, erratic, and emotional disorders.
Narcissistic Personality Disorder
This disorder is characterized by an inflated sense of self-worth and ego. People diagnosed with a narcissistic personality disorder often feel entitled, and demand to have preferential treatment and attention bestowed upon them. They may act as if they are more important than others, and some times believe that they have special powers or abilities that make them superior to those around them. These individuals tend to lack empathy, and may try to exploit others to suit their own needs.
Histrionic Personality Disorder
This disorder is characterized by extreme emotionality and attention-seeking. While someone with narcissistic personality disorder may demand attention because they believe that they are special, a person with histrionic personality disorder seeks out attention because it is uncomfortable for them to not be the center of attention. These individuals will often go to any length to draw attention to themselves. They may rapidly shift their expression of emotions, act or dress provocatively, and act theatrically, even over very minor instances. In many cases, these individuals overemphasize the importance and intimacy of relationships, leading to a feeling that they are too attached or clinging.
Borderline Personality Disorder
A borderline personality disorder is best characterized by difficulties in regulating emotions, often resulting in mood swings and impassivity. People afflicted with borderline personality disorder may display a fear of abandonment and exhibit impulsive behaviors in response to that fear. These individuals can rapidly cycle between polarized feelings, screaming “I hate you,” followed by a whimpering “Please don’t leave me.” It is not uncommon for these individuals to experience intense, uncontrollable bouts of anger or depressed mood. This rapid cycling can be problematic if a client is cycling between issues such as suicidal thoughts and intense bouts of anger and depression. Medication is often used to control symptoms including depressed mood, anxiety, and dissociative feelings. Hospitalization may be required in cases of extreme stress, impulsive, or suicidal behaviors.
Antisocial Personality Disorder
An antisocial personality disorder is characterized by a complete disregard for the rights or feelings of others. People diagnosed with this disorder are commonly referred to as “sociopaths,” due to their lack of regard for others, and lack of guilt or remorse for their behavior. These individuals are hostile and easily agitated, may take unnecessary risks, and often engage in poor or abusive relationships. It is not uncommon for these individuals to have trouble with the law due to homicidal or suicidal behaviors, gang participation and abusive tenancies. Like other disorders in this cluster, there are no medications that specifically treat it.
“Until psychiatrist Kurt Schneider (1887-1967) broadened the concept of personality disorder to include those who ‘suffer from their abnormality,’ personality disorder was more or less synonymous with antisocial personality disorder.”
psychologytoday.com
Are Cluster B Personality Disorders Pervasive in the United States?
The National Institute of Mental Health (NIMH) reports that 9.1 percent of American adults have at least one personality disorder. Nine percent of 328 million equals around 29.84 million people. Globally, it’s estimated that 13 percent of people experience personality disorders. Cluster B is a rarer group of personality disorders though. For example, narcissistic personality disorder affects less than 1 percent of the United States population. Of them, nearly three-fourths are men. A borderline personality disorder is apparent in about 1.6 percent of Americans. In America, 1.8 percent of people meet DSM-5 criteria for histrionic personality disorder. An antisocial personality disorder is more widespread with a 3 percent prevalence rate. When diagnosed, people with cluster B disorders are normally age 18 or older. However, many disorders get ignored and left untreated. Half of mentally ill United States residents don’t undergo effective treatment.
How Cluster B Personality Disorders Differ From Cluster A
Cluster A is made up of three diagnoses: paranoid, schizoid, and schizotypal personality disorders. Each disorder in cluster A causes bizarre thoughts and behaviors. People with cluster A personality disorders are deeply suspicious of others. They present illogical fears and feel threatened by non-threatening, harmless people or events. Similar to schizophrenia, cluster A disorders cause an uncontrollable alarm that bad things will happen. Cluster A focuses more on pervasive paranoia and hostility to others. In contrast, cluster B consists of personality disorders that cause overly dramatic responses. People with cluster B disorders usually don’t have delusional fears of others. Rather, they have strong emotional responses to stimuli and act out impulsively. Cluster A often makes individuals withdraw socially, whereas cluster B can make individuals aggressively lash out.
Ways Cluster B Personality Disorders are Different Than Cluster C
Cluster C consists of three other diagnoses: avoidant, dependent, and obsessive-compulsive personality disorders. Each cluster C personality disorder results in extremely high levels of anxiety. People with cluster C disorders are overly sensitive to disapproval and rejection. They’re consumed with fear about what others think of them. Low self-esteem, clinginess, and shyness are hallmark signs of cluster C personality disorders. Cluster C covers personality disorders that make individuals withdraw to avoid ridicule. Many strive for unattainable goals of perfectionism and feel ugly or inadequate when they think they fail. In contrast, people with cluster B disorders seek attention regardless of how others see them. Narcissists particularly see themselves as supremely attractive and successful. Unlike cluster C, cluster B covers disorders that cause overly outgoing and often provocative behaviors.
Common Symptoms of Cluster B Personality Disorders
According to the DSM-5, cluster B is all about emotional volatility. People with cluster B disorders have pronounced, exaggerated reactions to everyday events. Their variable behaviors are virtually impossible to predict. Their moods swing from feeling better than everyone to feeling alone and depressed. They build up an arrogant image of themselves that’s rather fragile. People with cluster B disorders may outwardly brag about their greatness while feeling unfilled inside. Some become so wrapped up in themselves than nobody else’s feelings matter. It’s common for individuals in cluster B to aggressively turn on others who ignore or don’t praise them. Impulsive acts of revenge without regret or shame are likely. Antisocial personality disorder is especially linked to anger and harmful violence without remorse. Therapy is essential to manage the striking symptoms of cluster B disorders.
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Potential Causes of Cluster B Personality Disorders
There isn’t one specific cause for every cluster B personality disorder. Psychologists generally agree that people are predisposed by their genetics. Certain gene characteristics impact the way human brains develop. Abnormal neural anatomy may explain the impulsivity in cluster B. Mental illness tends to pass on from generation to generation via genes. However, the other half of the nature vs. nurture debate also plays a role. People’s childhood and adult environment could influence their personality. Negative life events and bad, unstable relationships can trigger personality disorders. For instance, the death of a parent early in one’s life would be emotionally traumatic. Survivors of physical abuse and sexual assault are at the highest risk. There’s a strong correlation between childhood conduct disorders and cluster B. Addiction to drugs and alcohol often exacerbates the symptoms of a co-morbid personality disorder too.
Who Can Accurately Diagnose Cluster B Personality Disorders
Untreated cluster B disorders can quickly spiral out of control. Getting a proper medical diagnosis is imperative. Nobody should self-diagnose based on lists of symptoms online. Leave the job to highly trained mental health clinicians. Psychiatrists and psychologists are the ones who diagnose all personality disorders. These professionals have a doctoral degree, years of experience, and state licensing. Both psychiatrists and psychologists use the DSM-5 criteria to evaluate patients. Forming an official diagnosis isn’t a fast process. Most mental health experts take several hour-long sessions to get to know patients first. Frequently, psychiatrists and psychologists talk with close family members for a full picture of patients’ behaviors. Clinicians will check that symptoms aren’t due to one recent stressful event. Cluster B requires ongoing symptoms lasting at least 12 months.
Effective Treatments for Cluster B Personality Disorders
Mental health providers make custom treatment plans for every patient. Antisocial, borderline, histrionic, and narcissistic personality disorders will likely require slightly different interventions. Fortunately, there are several approaches to psychotherapy or “talk therapy” that can work. One popular kind called cognitive therapy strives to interrupt the cycle of dysfunctional thought patterns. Behavioral therapy seeks to remedy abnormal, impulsive behaviors by positively reinforcing positive behaviors. Cognitive-behavioral therapy combines both to combat distorted feelings and actions. Dialectical behavioral therapy helps identify and stop self-harm in people with borderline personality disorder. Humanistic therapy teaches cluster B patients how to respect the value of themselves and others. Art therapy involves creative exercises to express pent-up emotions and establish a real sense of self. Interpersonal therapy may also repair unstable family or romantic relationships that contribute to cluster B disorders.
Medications Used to Manage Cluster B Personality Disorders
Dealing with cluster B disorders isn’t as easy as taking a pill. As of May 2020, there isn’t an FDA-approved medicine that exclusively treats personality disorders. Nonetheless, psychiatrists have the power to prescribe oral medicines when needed. Disorders in cluster B are typically abated with mood stabilizers. Mood-stabilizing drugs, such as lithium, asenapine, and valproate, help control the sporadic emotional shifts. They’re essential for handling the up-down rollercoaster feelings of borderline personality disorder. Further, antidepressants like Zoloft, Prozac, or Celexa may prevent despair and suicidal thoughts. Anti-anxiety medicines called benzodiazepines, including Xanax, Valium, and Ativan, can reduce fears of failure or judgment. Psychiatrists could also use antipsychotic drugs like clozapine or aripiprazole. Antipsychotics clear the mind of fantastical delusions and mild out mania. People on these medications must be monitored closely by psychiatrists to avoid side effects.
Outlook for People Diagnosed With Cluster B Personality Disorders
Therapy and medication can help individuals cope well with cluster B disorders. People can learn to control their unpredictable urges and impulses over time. There isn’t a failsafe treatment to cure personality disorders though. Patients diagnosed in cluster B often struggle with interpersonal bonding. Dramatic, erratic behaviors can strain relationships. Even treated people will likely always experience intense, manic episodes. If untreated, the outlook is much worse though. People with cluster B disorders engage in risky behaviors. Individuals may suffer financial loss from gambling. People could put their physical health in jeopardy by binge eating. They could contract infections or get pregnant from unprotected sex. People with borderline personality disorder may cut themselves or attempt suicide. Those with antisocial personality disorder might hurt or even kill others and face prison time. Thus, treatment determines the future outlook.
Tips to Get People with Cluster B Personality Disorders Help
Seeing the red flags of cluster B disorders is worrisome for friends and family. Usually, people with personality disorders don’t recognize the problem themselves. People rely on the aid of loved ones to get into professional mental health treatment. Confronting individuals with personality disorders isn’t easy though. It’s best to create an intervention plan. Research cluster B disorders and treatments to get armed with facts. Approach the person in a calm, non-judgmental tone. Express concern, love, and respect for the individual. Never make people with cluster B disorders feel attacked because that could backfire dramatically. Offer unconditional support and show empathy. Having an intervention counselor involved could help. If the individual becomes combative, call for emergency assistance. Contact the National Suicide Prevention Line if they’re showing signs of self-injury.
Common Co-Morbidities for Individuals With Cluster B Disorders
People sometimes don’t have only antisocial, histrionic, narcissistic, or borderline personality disorder. It’s possible to have two or more disorders at the same time. These are called co-morbidities. People with cluster B disorders can suffer from anxiety or overwhelming, irrational fears. They could have bipolar disorder, which causes rapid manic mood swings from happy to sad. They might meet DSM-5 criteria for post-traumatic stress disorder after experiencing a horrific life event. They may have major depressive disorder with extremely low moods and apathy. They can abuse drugs and alcohol to self-medicate their personality disorder. People with cluster B disorders could develop anorexia or bulimia with their drive to be perfect. Having personality disorders from different clusters is even feasible. That’s why seeing a psychiatrist or psychologist is essential to address all co-morbid disorders.
Concluding Thoughts
Because these disorders are pervasive, and in many cases have existed for the majority of a patient’s life, treating these disorders requires careful attention. There are no medications available to treat either narcissistic, histrionic, borderline, or antisocial personality disorder directly. Doctors may work with patients and prescribe medications to control symptoms such as depression or anxiety, while long-term behavioral psychotherapy is considered to be the preferred treatment for patients with one of these personality disorders.
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